Beachside Primary Care LLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

BEACHSIDE PRIMARY CARE LLC

Practice address

1825 3Rd St N Ste B
Jacksonville Beach, FL 32250-4840

Phone

(904) 595-5826

Fax

(904) 595-5827

NPI assigned

Sep 1, 2022

Last updated

Dec 16, 2022By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Deborah Ghandour, PA-C, DHSCNPI 1053329599

Title

President

Phone

(904) 595-5826

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Deborah Lane Ghandour, PA-C, DHSC

  • Medical Physician Assistant
  • Jacksonville Beach, FL
  • NPI 1053329599
  Medicare reassignment Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1661990400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1671148800000",
    "number": "1386364032",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1825 3RD ST N STE B",
            "city": "JACKSONVILLE BEACH",
            "state": "FL",
            "postal_code": "322504840"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1825 3RD ST N STE B",
            "city": "JACKSONVILLE BEACH",
            "state": "FL",
            "postal_code": "322504840",
            "telephone_number": "904-595-5826",
            "fax_number": "904-595-5827"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEACHSIDE PRIMARY CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-09-01",
        "last_updated": "2022-12-16",
        "certification_date": "2022-12-16",
        "status": "A",
        "authorized_official_last_name": "GHANDOUR",
        "authorized_official_first_name": "DEBORAH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "904-595-5826",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PA-C, DHSC"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Primary Care Clinic/Center in Jacksonville Beach, FL
• Providers in Jacksonville Beach, FL by specialty
• Primary Care Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.